Syphilis is a sexually transmitted disease caused by Treponema
pallidum. The organism is a thin, delicate spirochete 6
to 20 μm long that has the appearance of a helical
coil on dark-field microscopy or immunofluorescence.
Human beings are the only host. Nearly all transmission is through
sexual contact, although very close physical contact between mucous
membranes might also permit transmission.1 Transmission
by transfusion has been documented. Congenital syphilis may occur transplacentally
or by passage through an infected birth canal. Long, clinically
latent periods are common; the infection may persist through the
patient’s lifetime with a variety of clinical manifestations.
Syphilis causes significant complications if untreated and facilitates
the transmission of HIV. Pediatricians may have to treat children
or adolescents with acquired syphilis or infants with congenital
syphilis, but the most common presenting problem is the management of
a well-appearing infant born to a serologically positive mother.
Whereas syphilis rates in the United States declined between
1990 and 2000, the rates in all categories, primary and secondary,
early-latent, late-latent, and congenital syphilis and all age,
sex, racial, and ethnic groups increased between 2005 and 2006.2 Primary
and secondary syphilis rates increased primarily in men to 5.7 cases
per 100,000; however, rates increased in women as well to 1.0 case
per 100,000. Rates were highest in the South and specific urban
areas in other regions. The increase in rates was largely attributed
to increased rates in men having sex with men, HIV coinfection and
high-risk sexual behavior. In 2006, the highest rates were seen
in persons ages 25 to 29 years. Reported primary and secondary syphilis
cases increased to 9,756 in 2006 from 8,724 in 2005, an increase of
11.8%. The overall 2006 rate of 3.3 cases/100,000
was greater than the Healthy People 2010 target of 0.2 cases per
Congenital syphilis rates in the United States declined from
1996 to 2005 with a 14% average yearly decrease and an
overall 74% decrease.2 However, the rate
of congenital syphilis increased 4% between 2005 and 2006 (from
8.2 to 8.5 cases per 100,000 live births) with 349 reported cases.
In 2006, 26 states, the District of Columbia, and one outlying area had
rates of congenital syphilis that exceeded the Healthy People target
of one case per 100,000 live births (eFigs. 288.1 and 288.2).3
Syphilis—reported cases by stage of infection:
United States, 1941–2006.
Congenital syphilis—rates for infants less than
1 year of age: United States, 1997–2006 and the healthy
people 2010 target.
Children and adolescents who acquire syphilis follow a clinical
course similar to adults. In infected children, sexual abuse must
be presumed ...